Paracetamol is ineffective for acute and chronic low back pain

Goodfellow Gems Logo

Goodfellow Gems

Paracetamol is ineffective for acute and chronic low-back pain

Paracetamol is a first-line analgesic and has been used for many conditions including low-back pain.

A randomised trial compared paracetamol with placebo for acute (<6 weeks) moderate to severe low back pain (+/- leg pain) in 550 primary care patients.1 Participants got either regular paracetamol, regular placebo or prn regime for four weeks and followed for 8 weeks. Recovery was defined as the first day pain scores reduced to 0-1/10 and remained at this level for 7 days.

The recovery rate at 12 weeks was 85% taking regular paracetamol, 84% in the placebo and 83% in the prn group. Their recovery curve was identical.  The study shows that reassuring patients about the natural prognosis is excellent for most patients with acute low-back pain.

A Cochrane review found the same results for acute and chronic low-back pain.2 

A US guideline suggests that most patients get better regardless of treatment and there are numerous other non-drug and drug options.3


  1. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet online (2014). Click here
  2. Paracetamol for low back pain. Cochrane Database of Systematic Reviews (2016). Click here
  3. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med (2017). Click here

    Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.

    This Gem is supported by:
    As published in NZ Doctor 22/11/2017